Landmark results in federal cases nationwide

Resources

What Is a TPE Audit? Understanding Targeted Probe and Educate Reviews

Pursuant to the Medicare Program Integrity Manual (Pub. 100-08), Chapter 3, Section 3.2.5, participating providers who fail to achieve acceptable error rates during Targeted Probe and Educate (TPE) audits may be subjected to 100 percent prepayment review, extrapolation, or referral to a Unified Program Integrity Contractor (UPIC) for further administrative action by CMS or its [...]

Chronic Care Management Billing Protocols – a Guide to Challenging DOJ Audit Data

Chronic Car Management is In the DOJ Spotlight. Explore Our Guide to Defending Your CCM Practice During a Healthcare Audit. [...]

Common Defenses in White-Collar Crimes

Explore the most effective defenses for federal white-collar crimes. This guide explains how to harness white-collar defenses and mitigate penalties for both organizations and individuals. [...]

DOJ Announces Healthcare Fraud Takedown: Legal Implications for Providers, Executives, and Healthcare Business Owners

The Department of Justice (DOJ) recently announced one of the largest healthcare fraud enforcement actions in U.S. history. According to the DOJ, the nationwide operation resulted in charges against 455 defendants in connection with more than $6.5 billion in alleged fraud. This enforcement action broadly targeted physicians, nurse practitioners, executives, marketers, medical business owners, and [...]

Healthcare Fraud Defense for Hospice Providers

Hospice service providers are one of the most heavily scrutinized segments of the U.S. healthcare industry. The Office of Inspector General (OIG) of the Department of Health and Human Services has flagged hospice billing as a persistent area of concern in its annual Work Plans for well over a decade. In fiscal year 2025 alone, [...]

Civil vs. Criminal Healthcare Fraud Cases

Mishandling an accusation of healthcare fraud can cost you and your facility millions of dollars in fines and potentially result in a prison sentence. Knowing how prosecutors coordinate civil and criminal investigations can save your practice, reduce individual and corporate penalties, and help you navigate your career seamlessly through a complex legal battle.  Lowther Walker [...]